Provider First Line Business Practice Location Address:
3000 NORTH LAKE BLVD.
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
TAHOE CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-583-2225
Provider Business Practice Location Address Fax Number:
801-382-6066
Provider Enumeration Date:
08/21/2006